THE BLOG

Gastro What? Gastroparesis

24/09/2014 10:36 | Updated 20 November 2014

So lets begin with a simple question? Do you remember the last time you had a stomach bug? The last time you had food poisoning? Or the time where you could not stop vomiting? Maybe the time you had the flu? Where you lacked energy unable to do anything? All of theses are what patients with gastroparesis live with daily. It is like a stomach bug, food poising or the flu that never goes away.

It is like all of a sudden your world is turned upside down. Trips to A&E/ER in the middle of the night. The worst part is when they don't know what's wrong with you. They tell you to go home your fine but really you just deteriorate. Most sufferers are even told that it is in their head like they are just imagining it; or worse that they might be anorexic or bulimic. Even after diagnosis till this day many visit hospitals they suspect, more like they believe that they have an eating disorder. Like some consultants have said even in the most trained eye it can be misdiagnosed.

What is gastroparesis?

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Literally translated gastroparesis means "Stomach paralysis". It is a chronic Long-lasting illness in which the stomach is unable to contract normally or empty itself of food so it cannot crush or push food into the small intestine. It is unable to further digest or absorb nutrients like a normal healthy person.

Symptoms:

• Early Satiety (Feeling full shortly after starting a meal)
• Chronic Vomiting (Mainly of undigested food)
• Lack of appetite
• Heartburn
• Abdominal pain
• Abdominal bloating
• Weight loss (without trying)
• Weight gain
• Erratic blood glucose levels (mainly in diabetes)
• Diarrhea
• Constipation
• Gastric reflux
• Spasms of the stomach wall
• Gastroesophageal reflux
• Chronic nausea
• Dehydration
• Malnutrition
• Inability to eat (severe cases)

Causes:

It is important to remember the cause of Gastroparesis is not a blockage. It is thought to be the damage of the vagus nerve, which controls the movement of the digestive system. If this is damaged then the muscles of the digestive system do not work, therefore it cannot empty itself and the movement is slow. There are many other causes of Gastroparesis one of the main one is Diabetes and the other is idiopathic (unknown cause). Other causes include Ehlers Danlos Syndrome, surgery of the digestive system, radiation treatments over the digestive system and some certain cancers. There are some medications hat can cause slow emptying of the stomach theses include:

• Narcotic
• Tricyclic antidepressants
• Calcium channel blockers
• Clonidine
• Dopamine agonists
• Lithium
• Nicotine
• Progesterone

Diagnosis:

A history of symptoms will be taken into account before a diagnosis is made. They may use the following testing to confirm a diagnosis. They include:
• A gastric emptying scan using scintigraphy, where you eat eggs, Toast or oatmeal containing a very small amount of a radioactive substance (99m Tc) that is detected on the scan - gastroparesis is diagnosed if more than 10% of the food is still lingers in your stomach four hours after eating
• Gastric manometry, where a thin tube containing a wire is passed down your throat and into your stomach to measure electrical and muscular activity in your stomach as you digest food to determine your rate of digestion
• Endoscopy, where a thin, flexible tube is passed down your throat and into your stomach to examine the stomach lining and rule out other possible causes
• A barium X-ray, where you swallow a liquid containing the chemical barium, which shows up on X-ray and allows radiologists to watch the passage of this solution through your digestive system
• A smart pill, where you swallow a small electronic device that sends back information about how fast it is travelling as it moves through your digestive tract

Treatment:

Gastroparesis cannot usually be cured, However dietary changes and medical treatments can help you control the condition.

Dietary changes:
• Have six smaller meals a day instead of three meals - This means you will have less food in the stomach so digestion is easier.
• Eat soft (well cooked) and liquid foods, which are easier to digest
• Chew food well before swallowing
• Drink non-carbonated liquids with each meal
• Walk or sit for two hours following a meal, rather than lying down
Avoid:
• hard-to-digest foods like vegetabels with their skins or high-fibre
• foods high in fat (these can slow down digestion)

Medication These medications can be provided to help the symptoms:
• Metoclopramide and Domperidone this is taken before food it helps contract stomach muscles it also reduce nausea and vomiting.
• Erythromycin, an antibiotic that also helps contract the stomach
• Antiemetic's, drugs that control nausea and vomiting

Botox
This is for severe cases of Gastroparesis - injecting botulinum toxin (Botox) into the valve between your stomach and small intestine, to relax it and keep it open for a longer period of time so food can pass through. This is done via endoscopy injection.
This is new treatment that so far has mixed results.

A feeding tube
This is for sever case for Gastroparesis when other treatments have failed.
There are different types tues available it all depends on temporary or permanent.
Nasojejunal tube is one that passes through the nose and into the small intestine with nutrients; this is a temporary tube.
Jejunostomy this is a tube that is surgically placed and by passes the stomach into jej. Through this special type of liquid feeds pass through.
PICC Line this is for the severe cases where the whole digestive system does not work or absorption does not occur. It is intravenous (parenteral) nutrition, where liquid nutrients are passed straight into your bloodstream via a catheter (a tiny flexible tube) that is fed into a large vein.

Electrical stimulation

This is also a new treatment option and has had mixed results. This is only done when medication and dietry changes don't work. It is done under a general anaesthetic, a pacemaker is surgically implanted into your body.The device is made up of a neurostimulator and two leads. The stimulating electrode of each lead is fixed to the muscle of your lower stomach and the connector end of each lead is attached to the neurostimulator, which is implanted under the skin of your tummy.
When the neurostimulator is turned on using a handheld external control, electrical impulses are delivered to the stomach. The rate and amplitude of stimulation can be adjusted.

Surgery
In some cases the lower part of the stomach is stapled or bypassed and the small intestine reattached to the remaining stomach to improve emptying of stomach contents. Rarely the stomach is completely removed.